| NAME | NCPDP ID | NPI | DEA NUMBER | STORE NAME | ADDRESS LINE 1 | ADDRESS LINE 2 | CITY | STATE/PROVINCE | POSTAL CODE | TYPE | COUNTRY CODE | SPECIALTY | 2017 NCPDP ID | 2017 NPI | 2017 DEA NUMBER | IDENTIFICATION | COMMUNICATION | ASSOCIATED ERX PERSON | FORMER LAST NAME | FORMER FIRST NAME | FORMER MIDDLE NAME | FORMER SUFFIX | FORMER PREFIX | 2017 COMMUNICATION | 2017 DIRECT ADDRESS | 2017 STATE LICENSE NUMBER | 2017 MEDICARE NUMBER | 2017 MEDICAID NUMBER | 2017 UPIN | 2017 HIN | 2017 MUTUALLY DEFINED |
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